The role of environmental factors in

allergiesProf. Witold Lukas

Department of Family Medicine, Silesian Medical Academy

Risk factors increasing probability of allergic sensitivity

• The time of exposure of internal and external factors (pregnancy, the neonatal period, early childhood).

• Different exposure (from the ones mentioned above) to viral (an increased frequency of RSV) and bacterial (a higher incidence of G-negative) infections.

• Type and intensity of exposure to: pollen (from plants or trees), mites, molds or tobacco smoke.

Internal risk factors augmenting allergic sensitivity

• Pregnancy

Immunity switches from type Th1 to Th2 (at birth

neonates predominantly have type Th2).

• Breast-feeding

The milk of women with atopic diseases contains decreased amounts of secretory IgA as well as polyunsaturated fatty acids.

Internal risk factors augmenting allergic sensitivity

• Newborns with atopic diseases

Delayed maturation of T and B lymphocytes. In some cases – excessive production of IgE precedes the onset of allergic symptoms.

Intestinal flora of a newborn:– healthy – a predominance of Lactobacillus –

stimulating type Th1 in the immune system– with atopic diseases – a deficiency of Lactobacillus

Reasons for recent changes in exposure to different type of viral and bacterial infections

• The consumption (from an early neonatal period) of food prepared under sterile conditions.

• Improvement in personal hygiene, a lack of common bacteria in the environment.

• Early application of broad-spectrum antibiotics.• A significant decrease in the incidence of

infectious diseases, including mostly morbilli, caused by the common use of vaccinations.

Reasons for recent changes in exposure to different types of viral and bacterial infections

• The improvement of household conditions – a higher standard of living – better sealing of windows in houses, worse ventilation, the use of air conditioning, augmenting exposure to molds.

• Fewer children in families.

• Decreased contact of children with their peer groups.

The allergic march – the life cycle of the allergy

0-6 mo - Predominance of gastro-intestinal symptoms; possible skin lesions

7-12 mo - Symptoms of atopic dermatitis of newborns; gastro-intestinal symptoms

2-3 yo - Asthma in early childhood

4-7 yo - Allergic rhinitis

8-14 yo - Bronchial asthma, allergic rhinitis

External risk factors causing allergic sensitivity

• Pollen

Grass – timothy

Weeds – ragweed

Trees – birch, alder, oak• Animal danders (pets – e.g. hamsters, cats)• Industrial dusts and irritant gases (ozone, sulfur

dioxide, nitrogen oxide, formaldehyde)• Automobile engine exhaust

Physical signs helpful in diagnosing allergic diseases

• the allergic salute– ‘rubbing’ of the nose• A horizontal ‘groove’ on the nose• eye ‘shadows’• Denis-Morgan lines on the palpebrae• an adenoidal face• secretory otitis media• paranasal sinusitis• geographic tongue

Signs of allergies of the upper respiratory tract

• Pruritus and tearing (lacrimation)

• Sneezing ‘fits’

• Nasal congestion

• Clear exudate rhinitis

• ‘Scratching’ of the throat

• Laryngeal dyspnea (shortness of breath)

Hypersensitivity to pollen

Pollen seasons:

• The end of Jannuary to the beginning of March - e.g. alder

• April - e.g. birch, maple

• May to the end of June - e.g. grass (including grain)

• August to September - e.g. weeds

Regional differences occur

Hypersensitivity to allergens

• Hypersensitivity to weeds – summer

• Hypersensitivity to dust mites – perennial, with exacerbation during the winter season (due to heating)

• Hypersensitivity to animal danders and feathers – perennial or incidental

Allergies to grass & tree pollens

• Prophylactic actions:– Avoid sleeping with an open window– Avoid walking between 12:00 and 15:00– Avoid driving with an open window– Avoid bicycling– Avoid exposure to smoke (due to burned

wood or grilled food)

Allergies to grass & tree pollens

• Recommendations– Walking after the rain– Wearing long sleeve shirts and trousers in case of

skin eruptions – Daily shower or bath (and washing one’s hair) as well

as changing clothes after walking or outdoor activities– Allowing air flow in the home during and after the rain– Creating a self-monitoring flowchart– Using Pollen Monitor available online at

http:/www.alergie.info.pl or by using the press, radio and/or TV

– Using the European pollen calendar

Allergies to grass & tree pollens

• Recommendations

– Spending time in places containting (theoretically) small amounts of pollen, e.g. closed pools, spaces without windows, places next to large water reservoirs.

– When planning vacations, taking into consideration differences in pollen seasons in various geographical regions of the country.

– Avoiding eating honey, drinking herbal teas, taking herbal medications or using fragrant topical herbal creams or lotions.

– Conveying information about possible cross-allergies, e.g. birch pollens.

– Avoiding strong fragrances – the elimination of bath/shower lotions, herbal cosmetics, hair sprays and perfumes.

Dust mite allergies

• Signs and symptoms:– Rhinitis– Nocturnal cough– Dyspnea (shortness of breath – SOB)

Perennial symptoms, with exacerbation during the heating season, i.e. winter(especially at night and in the morning).

Dust mite allergies - prophylactic actions

• Recommendations for patients:– Reducing high humidity at home and in the workplace

via installing a high efficiency air-filtering system or by keeping proper air-flow.

– Changing bed sheets frequently (1x per week), ‘freezing’ bed sheets frequently during the winter, using anti-allergic covers over the mattress and pillows.

– Avoiding exposure to velveteen fabrics, furs, dust-collecting furniture, draperies, wool covers, carpets.

– Avoiding being present during house/office cleaning and returning only after at least two hours post cleaning or dusting.

Dust mite allergies - prophylactic actions

• Recommendations for patients:– Avoid staying in the attic or basement.– Use the Acarex test to identify dust mites. – Use Acarosan preparation topically on one’s

mattress, furniture fabrics, rugs and carpets once every 4-6 months.

– Use Acaril liquid to rinse bed sheets that are washed in temperatures up to 60oC.

Allergies to fungal spores

• Signs:– Conjunctivitis (perennial with periods of

seasonal exacerbations)– Nasal congestion (edema of nasal mucosa)– Asthma

Signs and symptoms are perennial.

Patients allergic to outdoor fungal species remain asympthomatic in the winter.

Allergies to fungal spores

• Prophylactic actions in the home/flat:– Remove potted plants.– Remove or frequently change air humidifiers.– Avoid working in libraries, banks.– Avoid being present next to construction or demolition

sites.– Avoid picking mushrooms or forest walking after rain.– Exclude ‘blue’ cheese, dry fruit, mushrooms, wine and

beer from one’s diet.– Avoid staying in green-houses and compost prisms.– Avoid places with air conditioning.

Allergies to pet animal danders

• Mostly related to: hamsters, cats or birds (parrots, canaries)

• Prophylactic actions:– Removal of these pets/animals, especially

from the bedroom.– Wash away cat dander.

Food allergy

Signs

• Skin– Utricaria – acute & recurrent acute

• Respiratory tract– Rhinitis, wheezing or difficulty with breaching– Pharyngitis, laryngitis– Otitis– Bronchitis, chronic pneumonia– Asthma

Food allergies

Signs• Gastrointestinal (GI) tract

– Recurrent diarrhea or constipation– Abdominal pain– Colic pain in the neonatal period– Gastroesophageal reflux (GERD)

• The nervous system– Fatigue, increased somnolence– Attention deficit disorders– Hyperactivity disorders, aggression– Headaches– Epilepsy

Food allergies

Signs

• The musculoskeletal system– Pain in one’s extremities– Joints edema

• The urinary system – Proteinuria– Hematuria

Cross-reactions between pollen and food allergens (the presence of profiline in

pollens and foods)Pollens and types of foods

Grass Raw fruits or vegetables – apples, carrots, potatoes, tomatoes

Alder, birch treeNuts, apples, peaches, pineapples, carrots

Rye-grass Rye flour

Weeds Celery, melons, parsly, herbs

Latex Bananas, kiwi, avocado

Genetically modified food (GMO)

• An allergy to corn with Plant Incorporated Pepticide (PIP)

• An allergy to soya with the brasilian nut gene

Nutrition for allergyprophylaxis

• Breastfeeding - min. to 6 months• A hypoallergic diet for lactating women – the exclusion

of:– Milk– Eggs– Nuts– Cacao– Fish– Citrus fruits

• A gluten-free and hypoallergic diet to 1 year• A hypoallergic mix for neonates with a positive family

history of allergies